Skip to main content

Advertisement

SpringerLink
Log in

Treatment concepts for pes planovalgus with concomitant changes of the ankle joint

Behandlungskonzepte bei Pes Planovalgus mit begleitenden Veränderungen des oberen Sprunggelenks

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

A Publisher's Erratum to this article was published on 24 February 2021

This article has been updated

Abstract

Concomitant valgus deformities of the ankle joint are found in approximately 3% of patients with symptomatic flatfoot deformities. Conservative treatment is mostly successful only in the short term or in low-demand patients. The operative treatment of flatfoot deformities follows the standard algorithm for flatfoot treatment. The ankle joint can be treated while retaining mobility or by arthrodesis depending on the degree and rigidity of the deformity, degenerative changes, patient factors and expectations. Achieving an orthograde hindfoot and midfoot is obligatory for successful treatment as well as in ankle reconstructive or arthrodesis procedures.

Zusammenfassung

Begleitende Veränderungen des oberen Sprunggelenkes bei Patienten mit Pes Planovalgus-Deformitäten treten nur bei etwa 3 % der Patienten auf, stellen jedoch eine besondere therapeutische Herausforderung dar. Die konservative Therapie ist häufig nicht oder nur kurzfristig erfolgreich. Die Fußdeformität muss analog den Behandlungsschemata der Plattfußtherapie erfolgen. Als operative Behandlungsoption stehen grundsätzlich rekonstruktive oder arthrodesierende Verfahren zur Verfügung. Die Möglichkeit des Erhalts des oberen Sprunggelenks hängt von dem Ausmaß der Deformität, den degenerativen Veränderungen aber auch von Patientenfaktoren ab. Die Wiederherstellung einer orthograden Rück- und Mittelfußachse ist sowohl bei arthrodesierenden als auch bei rekonstruktiven Verfahren obligate Voraussetzung für eine erfolgreiche Behandlung.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Change history

Abbreviations

AAFD:

Adult acquired flatfoot deformity

AP:

Anteroposterior

CT:

Computed tomography

FD:

Flatfoot deformity

FDL:

Flexor digitorum longus

FF:

Flatfeet

MRI:

Magnetic resonance imaging

NC:

Naviculo-cuneiform

PTT:

Posterior tibial tendon

TAR:

Total ankle replacement

TCNL:

Tibiocalcaneonavicular ligament

TMT:

Tarsometatarsal joint

TN:

Tibionavicular

TTC:

Tibiotalocalcaneal

References

  1. Myerson M (1997) Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect 46:393–405

    CAS  PubMed  Google Scholar 

  2. Bluman E, Title C, Myerson M (2007) Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 12:233–249

    Article  PubMed  Google Scholar 

  3. Bluman E, Myerson M (2007) Stage IV posterior tibial tendon rupture. Foot Ankle Clin 12:341–362

    Article  PubMed  Google Scholar 

  4. Michelson J, Conti S, Jahss MH (1992) Survivorship analysis of tendon transfer surgery for posterior tibial tendon rupture. Orthop Trans 16:30

    Google Scholar 

  5. Ettinger S, Mattinger T, Yao D, Stukenborg C, Claassen L, Daniilidis K et al (2017) Outcomes after lengthening calcaneal osteotomy for flatfoot deformity: evans versus Hintermann. Foot Ankle Surg 23:57

    Google Scholar 

  6. Bernasconi A, Sadile F, Welck M, Mehdi N, Laborde J, Lintz F (2018) Role of tendoscopy in treating stage II posterior tibial tendon dysfunction. Foot Ankle Int 39:433–442

    Article  PubMed  Google Scholar 

  7. Deland JT (2001) The adult acquired flatfoot and spring ligament complex: pathology and implications for treatment. Foot Ankle Clin 6:129–135

    Article  CAS  PubMed  Google Scholar 

  8. Deland JT, de Asla RJ, Sung I‑H, Ernberg LA, Potter HG (2005) Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int 26:427–435

    Article  PubMed  Google Scholar 

  9. Balen PF, Helms CA (2001) Association of posterior tibial tendon injury with spring ligament injury, sinus tarsi abnormality, and plantar fasciitis on MR imaging. Am J Roentgenol 176:1137–1143

    Article  CAS  Google Scholar 

  10. Pisani G (2015) “Coxa pedis” today. Foot Ankle Surg 22:78–84

    Article  PubMed  Google Scholar 

  11. Campbell KJ, Michalski MP, Wilson KJ, Goldsmith MT, Wijdicks CA, LaPrade RF et al (2014) The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study. J Bone Joint Surg Am 96:e62

    Article  PubMed  Google Scholar 

  12. Cromeens BP, Kirchhoff CA, Patterson RM, Motley T, Stewart D, Fisher C et al (2015) An attachment-based description of the medial collateral and spring ligament complexes. Foot Ankle Int 36:710–721

    Article  PubMed  Google Scholar 

  13. Jordan M, Thomas M, Elser F, Fischer W (2018) Injuries of the medial collateral ligament and spring ligament complexes. Unfallchirurg 121:704–714

    Article  CAS  PubMed  Google Scholar 

  14. Boss AP, Hintermann B (2002) Anatomical study of the medial ankle ligament complex. Foot Ankle Int 23:547–553

    Article  PubMed  Google Scholar 

  15. Earll M, Wayne J, Brodrick C, Vokshoor A, Adelaar R (1996) Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study. Foot Ankle Int 17:317–324

    Article  CAS  PubMed  Google Scholar 

  16. Klerken T, Kosse NM, Aarts CAM, Louwerens JWK (2019) Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome. Foot Ankle Surg 25:247–250

    Article  PubMed  Google Scholar 

  17. Song SJ, Lee S, O’Malley MJ, Otis JC, Sung H, Deland JT (2000) Deltoid ligament strain after correction of acquired flatfoot deformity by triple arthrodesis. Foot Ankle Int 21:573–577

    Article  CAS  PubMed  Google Scholar 

  18. Resnick RB, Jahss MH, Choueka J, Kummer F, Hersch JC, Okereke E (1995) Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies. Foot Ankle Int 16:14–20

    Article  CAS  PubMed  Google Scholar 

  19. Hyer CF, Galli MM, Scott RT, Bussewitz B, Berlet GC (2014) Ankle valgus after hindfoot arthrodesis: a radiographic and chart comparison of the medial double and triple arthrodeses. J Foot Ankle Surg 53:55–58

    Article  PubMed  Google Scholar 

  20. Alvarez RG, Marini A, Schmitt C, Saltzman CL (2006) Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int 27:2–8

    Article  PubMed  Google Scholar 

  21. Wapner KL, Chao W (1999) Nonoperative treatment of posterior tibial tendon dysfunction. Clin Orthop Relat Res 365:39–45

    Article  Google Scholar 

  22. Kelly IP, Nunley JA (2001) Treatment of stage 4 adult acquired flatfoot. Foot Ankle Clin 6:167–178

    Article  CAS  PubMed  Google Scholar 

  23. Bohay DR, Anderson JG (2003) Stage IV posterior tibial tendon insufficiency: the tilted ankle. Foot Ankle Clin 8:619–636

    Article  PubMed  Google Scholar 

  24. Smith JT, Bluman EM (2012) Update on stage IV acquired adult flatfoot disorder when the deltoid ligament becomes dysfunctional. Foot Ankle Clin 17:351–360

    Article  PubMed  Google Scholar 

  25. Brunner S, Knupp M, Hintermann B (2010) Total ankle replacement for the valgus unstable osteoarthritic ankle. Tech Foot Ankle Surg 9:165–174

    Article  Google Scholar 

  26. Ellis SJ, Williams BR, Wagshul AD, Pavlov H, Deland JT (2010) Deltoid ligament reconstruction with peroneus longus autograft in flatfoot deformity. Foot Ankle Int 31:781–789

    Article  PubMed  Google Scholar 

  27. Jeng CL, Bluman EM, Myerson MS (2011) Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity. Foot Ankle Int 32:21–30

    Article  PubMed  Google Scholar 

  28. Krähenbühl N, Zwicky L, Bolliger L, Schädelin S, Hintermann B, Knupp M (2017) Mid- to long-term results of supramalleolar osteotomy. Foot Ankle Int 38:124–132

    Article  PubMed  Google Scholar 

  29. Hintermann B, Valderrabano V, Boss A, Trouillier HH, Dick W (2004) Medial ankle instability. Am J Sports Med 32:183–190

    Article  PubMed  Google Scholar 

  30. Nery C, Lemos AVKC, Raduan F, Mansur NSB, Baumfeld D (2018) Combined spring and deltoid ligament repair in adult-acquired flatfoot. Foot Ankle Int 39:903–907

    Article  PubMed  Google Scholar 

  31. Patel MS, Barbosa MP, Kadakia AR (2017) Role of spring and deltoid ligament reconstruction for adult acquired flatfoot deformity. Tech Foot Ankle Surg 16:124–135

    Article  Google Scholar 

  32. Clanton TO, Williams BT, James EW, Campbell KJ, Rasmussen MT, Haytmanek CT et al (2015) Radiographic identification of the deltoid ligament complex of the medial ankle. Am J Sports Med 43:2753–2762

    Article  PubMed  Google Scholar 

  33. Williams BR, Ellis SJ, Deyer TW, Pavlov H, Deland JT (2010) Reconstruction of the spring ligament using a peroneus longus autograft tendon transfer. Foot Ankle Int 31:567–577

    Article  PubMed  Google Scholar 

  34. Deland JT, de Asla RJ, Segal A (2004) Reconstruction of the chronically failed deltoid ligament: a new technique. Foot Ankle Int 25:795–799

    Article  PubMed  Google Scholar 

  35. Johnson CH, Christensen JC (1999) Biomechanics of the first ray part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model. J Foot Ankle Surg 38:313–321

    Article  CAS  PubMed  Google Scholar 

  36. Rasmussen O (1985) Stability of the ankle joint. Analysis of the function and traumatology of the ankle ligaments. Acta Orthop Scand Suppl 211:1–75

    Article  CAS  PubMed  Google Scholar 

  37. Xu C, Qing LM, Wang C, Liu H (2019) Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. J Orthop Surg Res 14:114

    Article  PubMed  PubMed Central  Google Scholar 

  38. Brodell JD, MacDonald A, Perkins JA, Deland JT, Oh I (2019) Deltoid-spring ligament reconstruction in adult acquired flatfoot deformity with medial peritalar instability. Foot Ankle Int 40:753–761

    Article  PubMed  Google Scholar 

  39. Valderrabano V, Paul J, Monika H, Pagenstert GI, Henninger HB, Barg A (2013) Joint-preserving surgery of valgus ankle osteoarthritis. Foot Ankle Clin 18:481–502

    Article  PubMed  Google Scholar 

  40. de Keijzer DR, Joling BSH, Sierevelt IN, Hoornenborg D, Kerkhoffs GMMJ, Haverkamp D (2019) Influence of preoperative tibiotalar alignment in the coronal plane on the survival of total ankle replacement: a systematic review. Foot Ankle Int 41:1071100719886817

    Google Scholar 

  41. Schuberth JM, Christensen JC, Seidenstricker CL (2017) Total ankle replacement with severe valgus deformity: technique and surgical strategy. J Foot Ankle Surg 56:618–627

    Article  PubMed  Google Scholar 

  42. Vulcano E, Deland JT, Ellis SJ (2013) Approach and treatment of the adult acquired flatfoot deformity. Curr Rev Musculoskelet Med 6:294–303

    Article  PubMed  PubMed Central  Google Scholar 

  43. Colin F, Zwicky L, Barg A, Hintermann B (2013) Peritalar instability after tibiotalar fusion for valgus unstable ankle in stage IV adult acquired flatfoot deformity. Foot Ankle Int 34:1677–1682

    Article  PubMed  Google Scholar 

  44. Tenenbaum S, Coleman SC, Brodsky JW (2014) Improvement in gait following combined ankle and subtalar arthrodesis. J Bone Joint Surg Am 96:1863–1869

    Article  PubMed  Google Scholar 

  45. Papa JA, Myerson MS (1992) Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot. J Bone Joint Surg 74:1042–1049

    Article  CAS  PubMed  Google Scholar 

  46. Ettinger S, Stukenborg-Colsman C, Plaass C, Yao D, Claassen L, Berger S et al (2016) Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 136:457–462

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Straße 1–7, 30627, Hannover, Germany

    Christian Plaass,  Leif Claassen,  Sarah Ettinger,  Daiwei Yao,  Matthias Lerch &  Christina Stukenborg-Colsman

  2. Foot and Ankle Reconstruction Unit of the Orthopaedic Department, St. Maartenskliniek, Hengstdal 3, 6574, Ubbergen, NA, The Netherlands

    Jan Willem Louwerens MD, PhD & Christian Donken MD, PhD

Authors
  1. Christian Plaass
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Willem Louwerens MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leif Claassen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Ettinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daiwei Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthias Lerch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christina Stukenborg-Colsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christian Donken MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Plaass.

Ethics declarations

Conflict of interest

C. Plaass is a paid consultant for Medartis. He is also a paid speaker for OPED. M. Lerch received study funding from Arthrex GmbH and is consultant for Arthrex GmbH. C. Stukenborg-Colsman is a paid consultant for Medartis and Stryker. J.W. Louwerens, L. Claassen, S. Ettinger, D. Yao and C. Donken declare that they have no competing interests regarding this article.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from all individual participants or their legal representatives for whom identifying information is included in this article.

Additional information

The original online version of this article was revised: Unfortunately, a preliminary version of the article was published.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Plaass, C., Louwerens, J.W., Claassen, L. et al. Treatment concepts for pes planovalgus with concomitant changes of the ankle joint. Orthopäde 49, 991–999 (2020). https://doi.org/10.1007/s00132-020-03996-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-020-03996-4

Keywords

Schlüsselwörter

Search

Navigation